This classic resource offers complete coverage of nursing case management - from theoretical background and historical perspective to practical applications and how the field is changing to meet the challenges of today's health care environment. It focuses on the implementation of various case management models used throughout the United States and abroad. Key topics include the impact of public policy on health care; understanding the effects of health care reimbursement and its application at the patient level; throughput and capacity management; the impact of the revenue cycle; compliance and regulatory issues; and principles needed to improve case manager-client interaction. This helpful resource is designed to help nurse case managers assess their organization's readiness for case management, prepare and implement a plan to achieve necessary improvements and evaluate the plan's success. Includes numerous proven case management models currently being used in institutions across the country Organized to take the nursing case manager on a journey from the historical development of nursing case management to the successful implementation of a case management program Offers detailed guidance for planning, implementing, and evaluating a case management program Outlines the planning process with information on key topics such as analysis of the organization, the role of the organization's members, selection criteria for new case managers, case management education, credentialing, and partnerships Features guidelines for implementing a case management program with information on ethical issues, technology, compliance, and regulatory issues Addresses the evaluation component of developing and implementing a case management program by presenting information on outcomes, research, documentation, continuous quality improvement, measuring cost effectiveness, care continuum, and evidence-based practice Presents acute care and community based models of case management Highlights the evolution of collaborative models of case management, addressing key elements of joint decision-making, shared accountability, and interdisciplinary systems of care Addresses health care delivery through case management and public policy by presenting current legislative issues and their affect on both health care reimbursement and the application of care at the patient level Presents the insights, experiences, and advice of nursing administrators who have researched and successfully implemented nursing case management programs in various facilities A new chapter, Telehealth Applications for Case Management, introduces the concept of telehealth; provides examples of telehealth usage in women's health, chronic disease management, and mental health; and summarizes the evidence that supports telehealth and identifies existing issues and challenges. Case Management: Life at the Intersection of Margin and Mission, is a new chapter that highlights strategies case managers and others can use to optimize their organizations' financial outcomes while simultaneously improving clinical outcomes for their patients. It emphasizes the work of case managers in the financial arena of health care, including revenue cycle management. A new chapter, Maximizing Reimbursement through Accurate Documentation and Coding, provides tips and strategies on maximizing reimbursement by designing and implementing programs focused on improving the physician's documentation. Effective Management Tools for Case Management Leaders: Strategy Maps and Balanced Scorecards, A Case Study is a new chapter that discusses strategy maps and balanced scorecards and their role in transforming an organization's mission and strategy into a management system and a comprehensive set of performance measures. Features updated information on HIPPA regulation (Health Insurance Portability and Accountability Act), patient safety and confidentiality issues, case management for Medicare patients, Medicare legislation, and utilization management.

This practical, "hands-on" guide includes vital information every case manager and administrator of a case management program need to be successful. A useful resource for working in the changing face of healthcare, it addresses case managers in all settings with an emphasis on nurse case managers and their role in providing patient care and containing costs. Focusing on the "nuts and bolts" aspects of case management, it discusses the operations of case management programs based on the authors' first hand experiences. Case Management Tip boxes in each chapter highlight important tips and provide easy access to this information. Case studies in several chapters address possible situations the case manager may confront along with the most effective solutions. Key points at the end of each chapter summarize pertinent information. Appendices provide extensive examples of forms and multi-disciplinary action plans used in various healthcare settings. Six new chapters have been added on Utilization Management (Chapter 5), Transitional Planning (Chapter 6), Disease Management (Chapter 7), Application of Legal Concepts in Case Management Practice (Chapter 17), Ethical Issues in Case Management (Chapter 18), and Internet Resources and Case Management (Chapter 19). Content on Financial Reimbursement Systems has been expanded to cover community case management issues such as the new community reimbursement systems for ambulatory, home, and long-term care. Information on community-based models is covered in more detail in response to growth in this area - including managed care, telephonic, rehabilitation, sub-acute, and long-term and emergency department case management. The chapter on Skills for Successful Case Management has been expanded to include a discussion of additional skills such as clinical reasoning, cost-effectiveness, and negotiation among others. Content on Developing Case Management Plans has been updated to include more content on community plans and a detailed review of the types of case management plans, including algorithms. The chapter on Quality Patient Care has been updated to include an historical review, minimum data sets, report cards, and the relationships between outcomes and quality. Quality indicators and organizations across the continuum are included. Appendices have been expanded to include community-based case management plans, home care plans, and long term care plans.